This guide is dedicated to the memory of my dear father, Philip Allen (Shmaryahu Pinchas ben Yisrael ve Hinda Chaya, zichrono livracha), who lived with us in Jerusalem during the last year of his life, and passed from this world on Tisha Ba’av, 5767. I’ve created this Guide to assist others who are considering bringing their elderly parents to Israel, in order to ease the process for all concerned. I learned a lot by bringing my dad here, and it is my pleasure to share these insights with you.

INTRODUCTION Jewish tradition emphasizes that taking care of a parent is a tremendous mitzvah. As the Talmud in Shabbat 127a says: “These are the fruits a person enjoys in this world, and continues to enjoy them in the World to Come. They are: honoring one’s parents…”

This is particularly true when the elderly have diminished physical and mental capacity, and are confronting their own mortality. But the task of taking care of them need not feel overwhelming. It is my hope that this guide will give you reassurance, save you time and unnecessary aggravation, and give you precious quality time to spend with your loved one.

(Note: This Guide is very Jerusalem-oriented. Services for the aged might vary significantly in other parts of the country.)

COPING While it’s a great mitzvah to take care of an aging parent, and to bring them to Israel, do not underestimate the time and energy it will demand of you, the child/caretaker. You are their advocate, in every sense of the word – especially if your parent doesn’t know Hebrew and is unfamiliar with the Israeli system. You have to remain flexible, even though you may have to hold down a job at the same time, and have demands of your own family.

My advice: Get as much help as possible. Galvanize your family members. Take “time out” for yourself, and your spouse. Set aside time to go out for a nice dinner, or just go for a walk. Take a weekend away for you and your spouse. Try to network with other people who have brought their parents here.

Feel free to contact me, and I will try to offer whatever extra advice I can.

ALIYAH The scenario is common: Your elderly parent is managing fine on their own, and suddenly they face a health crisis that necessitates intervention on a child’s part. The problem is that you have made your life in Israel, and then the difficult decision is made: it’s time to bring your parent to Israel, so you can keep a close eye on their physical and emotional needs. The elderly need an advocate; someone to make the hard decisions for them. A caretaker cannot do this for them, or replace a child/relative.

It is very important to have your parent formally make Aliyah, as one of the benefits is a guarantee of receiving full health coverage, no matter what the pre-existing condition. Don’t fall into the trap of thinking that a policy from abroad will cover them in Israel. Traveler’s health insurance can be very costly, and may not cover pre-existing conditions. Medicare coverage doesn’t cover a person when they are abroad. Check your parent’s policy carefully if they have other private insurance policies, and see what it covers — and for how long — if the person is abroad.

Making Aliyah Arrangements In the US and Canada, a tik (file) is no longer opened with the Jewish Agency. There is a new “one-stop-shop,” whereby potential Olim fill out only one application for Aliyah. The application can either be received through the Nefesh B’Nefesh (NBN) office, or can be downloaded from the NBN website, or even completed on their website. Please see Nefesh B’Nefesh website or contact tel: Israel 02-659-5800; tel: North America 1-866-4-ALIYAH, 1-(866)- 425-4924.

Try to minimize shlepping your elderly parent down; find out when they absolutely need to come down for an interview. As part of the Aliyah process, an interview with your local Aliyah Shaliach (The Jewish Agency for Israel representative) is required. If your parent is homebound, there may be a possibility, depending on location, of having a home interview. It is important to contact the local Shaliach to check if this option is available in your area.

For those making Aliyah from other countries, contact your local Aliyah Office and speak with a shaliach.

The Aliyah process can be quick and easy, provided you have all the necessary documents in order. (It took us only 4 days to bring my dad over to Israel!) However, the approval process can take up to two months after the application and all of the required documents have been submitted.

You will need original documents to get the process started: • Birth Certificate – Original • Marriage Certificate – Original (if both parents are still alive) • Divorce Decree – Original (if relevant) • Death Certificate of Spouse – Original • Letter from your rabbi confirming that he/she knows you are Jewish, born of a Jewish mother or a conversion certificate – Original • You may be asked to provide a letter from your parent’s doctor indicating your parent’s medical condition.

It is very important to provide the original documents as noted above. Aliyah officials are very strict about this.

Note that your parent will be given a free one-way plane ticket to Israel. Make sure to order a wheelchair! (Even if your parent says they don’t need it!) This will make things a lot easier for them at the airport…and you!

This fabulous organization streamlines a lot of the Aliyah process. It is now the primary address for Aliyah from North America. NBN will assist you with all aspects of the Aliyah planning, including arranging a flight for your parent. Your parent will have a choice of joining an NBN charter flight, participating in group flight (a block of 50-100 Olim traveling together on a regular El Al flight), or flying independently. You may consult with an NBN social worker on the phone, meet with her in person, or communicate by email (retirees@nbn.org.il).

Word of Advice: Make sure to have Power of Attorney over all your parent’s foreign bank accounts in the U.S. (or their country of origin), and get online access to their accounts. This way you can manage their finances, pay bills in Israel, etc. Also, if your parent is still maintaining a home abroad, set up online accounts with utility companies, etc., so these can be paid online as well.

To see in detail what the process will be once you arrive in Israel, see our Post Aliyah Guide.

LEGAL After your parent has a Teudat Zehut (with picture), it is important to set up an appointment with a lawyer as soon as possible. Having these documents set up will save you time and aggravation. • Power of Attorney (PoA) • Living Will (Do Not Resuscitate): Important to have with you in case your parent needs to go to the hospital. • Will in Israel: This will expedite probating procedures and save you a lot of headaches. • Banking – Power of Attorney: You need a special PoA from the Israeli bank where your parent has an account. You will have to bring your parent with you to open the account and to sign the necessary documents. Check with the bank if they can provide any home service. • Legal document that confirms that you have the legal power to take over your parent’s finances when they are incapable of taking care of their financial affairs.

LIVING ARRANGEMENTS

Living with You

When we brought my father to Israel, he lived with us. Little did we know that this would be the last year of his life, and undoubtedly it was a special year for us all. Eventually, a foreign worker came to live with us as well. Though at first it seemed like a daunting decision, I am so glad we went this route.

My father was a very easy-going, undemanding, and witty individual. That said, having an elderly parent come and live with you is not an easy decision, and comes with a significant loss of privacy to everyone. There is a period of adjustment, both emotional and practical.

On the practical level, you will need to make sure that your home is set up for an elderly person. The suggestions below also apply if you set up your parent in an apartment on their own: • Handrails in the bath/shower and if needed by the toilet • A special “seat” in the bath if your parent is unable to stand • A “riser” on the toilet • Handrails around staircases to your apartment building • Cane/walker/wheelchair – it’s good to have these on hand, in case you suddenly need them • Hospital bed • Good idea to have an oxygen tank available at home

If you don’t have a foreign worker living with you, be prepared for extra work – everything from getting your parent ready in the morning and in the evening, possibly preparing everything for them, from meals to personal hygiene.

Living in their own apartment If you go this route, make sure the apartment is near where you live, and (obviously) as close to the ground floor as possible, or is equipped with an elevator. Although at first your parent may be able to handle living alone, keep your antennae out for any deterioration in their ability to live alone. You may have to get a foreign worker at some point, and “sooner rather than later” is always preferable.

Nursing Homes, and Assisted Living Residences that Cater to the Elderly There are several public and private options in Jerusalem. While they provide a variety of services – from meals, social activities, to critical care – be aware that private facilities can be very costly.

Most private nursing homes have different levels of care within the facility, to accommodate your parent’s health situation, which can deteriorate. Most have a doctor on call, and have nursing help as well.

For a more detailed listing of Assisted Living facilities and Nursing Homes in Israel, see the following link.

BITUACH LEUMI AND CHOK SIYUD (The Nursing Care Law)Bituach Leumi is an important player in your parent’s care. Though no one likes dealing with a big bureaucracy, don’t be disillusioned: The private health care agencies (see below) may help you register and work with Bituach Leumi.

The private health care agencies work with Bituach Leumi. Thus it is in your interest, and the health-care agency’s interest, to have your parent registered and assessed by Bituach Leumi.

Once your parent has been assessed by a Bituach Leumi representative, you may be eligible for financial assistance (kitzba) and for health-care “hours”.

It’s a good idea to have a workup by a geriatric physician in order to have proof of your parent’s physical and mental capabilities. If your parent has signed up with Macabbi’s health plan, they provide a 3-hour assessment with gerontologist Dr. Shelly Sternberg. This includes mental and physical evaluations, as well as a consultation with a social worker. This report will help convince Bituach Leumi that your parent should receive hours for assistance.

A person from Bituach Leumi will come to the home to interview and assess your parent. Make sure you have documentation from the geriatric/family physician, as well as copies of your parent’s income, so you can prove physical need as well as financial need.

Once you receive notification by Bituach Leumi as to how many hours your parent is eligible for (up to 18 hours per week), make sure to use all the hours you are given! Otherwise, Bituach Leumi will eventually reduce the number of hours, and you will waste time trying to convince them that you need these hours (or will need them in the coming months/year as your parent’s health deteriorates).

MEDICAL COVERAGEChoosing your parent’s medical plan (Kupat Cholim) and physicians are extremely important decisions. I am very sorry to report from my experience that most family physicians are reticent about taking the elderly on as patients. Try your own physician for starters; keep begging/pleading/use protekzia, to get them to take them on.

Which Kupat Cholim is best for the elderly?Deciding on the right Kupat Cholim plan is extremely important. Each Kupah differs in regard to services for the elderly. I am only familiar with Macabbi, where my father was registered. They have very pleasant offices in Jerusalem, and a convenient parking lot with an elevator in the building that enables easy access for the elderly.

Most doctors accept Maccabi, and you can choose from a nice selection of physicians (provided that their practices accept new patients). Since my father was over 80 years old, a physical therapist from Maccabi came to the house once a week to work with him for about 30 minutes.

It is important to find out each Kupah’s “end of life” care; the times when your parent is most needy/ill and significantly less mobile, and the strain is hardest on you. For instance, in June-July 2007, when my father needed home hospice care, we found that Macabbi’s home hospice service didn’t include service on the weekends. (We were told that on the weekends we could call a number and leave a message, and someone would get back to us on Sunday. Please note that this policy may have changed since July 2007.)

Since we found this didn’t meet our needs, Macabbi instead referred us to Hadassah – Mt. Scopus’s hospice service. In addition to Hadassah’s general home hospice services, we were able to talk to a hospice nurse in an emergency on the weekends. Please contact me, and I will give you my assessment of Hadassah’s home hospice service.

From what I understand, Clalit has very extensive services for the elderly. But I don’t know this first hand. If anybody has more information, please contact me and I will incorporate it into this Guide. I am also not familiar with Meuhedet’s services for the elderly, although I understand that Meuhedet will send a representative to your parent’s home to sign them up.

Very important: Find out which medications the Kupah approves. You should already have a good idea what medications your parent is taking, so it’s a good idea to check this, so you won’t have a nasty surprise and learn that some medications aren’t covered in the basket of approved medications. Should certain medications not be covered, find out how much they cost privately. Also, find out what services each kupah provides at your parent’s residence (blood/urine tests? Physical therapy? Will a physician come to the home in an emergency? Pedicure care?, etc.). Nefesh B’Nefesh recommends bringing a three month supply of medications with you when making Aliyah.

Good to Know: • Your parent will have the opportunity to register for the health plan of his choice upon their arrival at Ben Gurion Airport. It is recommended to choose the health plan immediately to ensure that he/she has immediate coverage. Alternatively, it is possible to go the local post office and register for the health plan of choice.

• If your parent is over 80 years old: most of the Kupot will send a technician to your parent’s home to take blood and urine samples. Get this set up through your family physician.

• If you get a prescription from your doctor for “Ensure”, you can get this nutritious liquid food for free from your kupat cholim central pharmacy.

• In addition to lending medical equipment, Yad Sarah also runs:

Exhibition and Guidance Centers, which direct people to wise choices in terms of equipment, services and care-giving techniques

Tourism Service, which helps short-term visitors get organized with equipment and services.

Yad Sarah services include an “emergency call button” and “legal advice for elders”

SOCIAL FRAMEWORKS: WHAT WILL MY PARENT DO ALL DAY? Perhaps the biggest challenge for you and your parent is finding suitable social activities for them. Having your parent engaged with others is crucial to their well-being (and yours!). There are several options, depending on the mental status, mobility and motivation of your parent. You’ll need to “shop around” to see what’s the best fit for your parent. Here are some options:

• Melabev – This amazing organization provides day-care programs for the elderly. Their services are geared to those senior citizens with varying degrees of dementia and Alzheimer’s disease. They have an English program in Talpiot, with a wonderful and caring staff. They also run a variety of Hebrew programs throughout Jerusalem, and in Beit Shemesh and Pisgat Zeev. You can arrange for their van to pick up your parent. On a personal note: They were absolute life-savers for us and my father loved going there every day. Tel: 02-653-7591/ 1-700-70-4533, Email: melabev.org@gmail.com or orly@melabev.org. Website: www.melabev.org. • AACI – The Association of Americans and Canadians in Israel holds special senior activities (usually a lecture) once a week, and lots of other activities for people of all ages throughout the week. 11 Pinsker Street, Talbieh, Jerusalem, 02-5661181, click here for more info

• OU Center – Located on Keren HaYesod street, this organization is jumping during the week with lots of interesting lectures geared to the modern Orthodox population. Many seniors attend theses lectures and activities. Listing of adult programs: https://www.ouisrael.org/events/, 22 Keren Hayesod, P.O.B. 37015, Jerusalem 91370, Israel. Tel.: (02) 5667787, Fax: (02) 5617432, E-mail: israelcenter@ou.org • Yeshivot – It’s a good idea to contact various yeshivot that have one-year programs for post-high school Anglos who are spending their “gap year” in Israel. The yeshivot often require the students to take on a volunteer project once a week. See if they have students who would be willing to work with the elderly for an hour or so a week. (Keep in mind that these students may often cancel on you, as they have many competing activities that may sometimes conflict with their time slot with your parent.)

The Israeli government has created an online calculator (in Hebrew) for Holocaust survivors to calculate whether or not they are eligible for benefits. One needs to have Israeli citizenship to use this tool. See http://zakaim.mof.gov.il/. As well, the Foundation for the Benefit of Holocaust Victims in Israel has an English website which can be accessed here: http://k-shoa.org./.

HEALTH CARE AGENCIESThe health care agencies are a great source of information and can really help you streamline the Israeli bureaucracy. They generally don’t take money from you for their services, since they get money from the government if your parent qualifies for Bituach Leumi assistance.

The benefits of using an agency are manifold: They often will fill out forms for Bituach Leumi (and other bureaucratic forms) with you, and generally will process the forms for you as well. This is a huge relief, and tremendous time-saver (plus they come to your home to do it as well!)

In order to get a foreign worker, you need to go through the accredited health care agencies. But they are helpful before that stage as well. You may qualify for Bituach Leumi for several hours of assistance (through Chok Siyud, the Nursing Care Law), and the agencies will get you helpers for those hours, who will assist your parent with showering, walking, light housekeeping, shopping, and general entertaining. See the article Hiring a Foreign Care Worker for more information and listing of agencies.

• The large agency in Jerusalem is Goldman (Tel: 02-625-1141), and many people in the Anglo community use them. • We used Natan – (Tel: 02-500-3841).

General Information Foreign workers hop from one agency to another, after they have been in the country and have concluded work with their first employer. If you have found a foreign worker on your own, you don’t have to pay the finder’s fee to the agency. Even if the worker you want to hire is connected to a different agency, they can then get “reregistered” with your agency. This doesn’t cost you anything.

If you hire a foreign worker, and for some reason he/she doesn’t work out, you can hire another one legally. But after the second one, it becomes problematic. So be careful who you hire the first time, because your options are limited.

Be aware: when your foreign worker has a day off, or is sick and unable to work, legally you can’t “fill in” with another foreign worker. According to the law, the person who works with your parent as a “fill-in” has to have Israeli citizenship.

Fees • Salary is between 1,200 – 1,500 NIS per week. • Pocket money: Legally, you have to give them NIS 100 per week (this sum may have increased since this manual was written). • Health insurance – you have to provide this; your health care agency will recommend places. • Bituach Leumi – you have to provide this.

Get references from the worker’s past employers! Find out what they were like; how well they got along with the elderly; if they watched lots of TV; how prompt they were about getting back in time after their day off; if the foreign worker got sick a lot.

When interviewing a foreign worker: Try to get a feeling of the level of their English. (The agencies will often say that the foreign worker they recommend has “excellent” English, but keep in mind that they have a vested interest in placing their person, and the foreign worker’s English may be far below standard.) This is important not only because they need to communicate with your parent, and you, easily. But it is also necessary if they need to call an ambulance/doctor if you are not available. In the event of a medical emergency, communicating properly in English could save your parent’s life!

Questions to ask during the interview with the foreign worker:Find out where they worked previously; why they left; how long they worked there; when they came to Israel; which agency they are currently connected with. Clarify which days they want off. Check if they smoke. See if they can meet the physical needs of your parent (especially lifting) as well as emotional needs (will they become a friend and companion to your parent? Are they friendly as well as polite and helpful?)

Talk to several candidates. You’ll see that there is a wide range of personalities and capabilities. Make sure you feel comfortable with the foreign worker before you introduce them to your parent, since meeting a new caretaker can be very unsettling to the elderly (and often they put up resistance to having someone — besides you! – live with/take care of them).

Where to find foreign workers:Although your agency will recommend foreign workers to you, you don’t have to hire the people they send you. Recommendations are the best way to find a suitable foreign worker, so network with people you know who have foreign workers for their parents.

Also, contact Melabev, Tel: 02-653-7591, 1-700-70-4533, melabev.org@gmail.com or orly@melabev.org and ask if you can go down to their English moadon (152 Derech Beit Lechem St, 02-651-6467). There, you will find lots (some days up to 15!) of foreign workers who come each day with their charges. They speak English, and are a great networking resource. Also, be sure to ask the English Melabev coordinator, Marsha Donshik, 052-720-3007 if she knows of any foreign workers who are looking for work.

Another source is Janglo (www.janglo.net). Post a message that you are looking for a foreign worker, and also look through their archives to see who is available. (Often, it takes a while for foreign workers to find employment, so you may get lucky and find someone who has good recommendations and is available.) Again, networking is your best bet.

Agencies:• Goldman – This is a large agency and has a large pool of foreign workers. (Tel: 02-625-1141). Many Anglos use them. • Natan – (Tel: 02-500-3841). This is the agency we used. They were great helping us deal with the various bureaucracies.

Be aware: Stay away from any agency that holds on to a foreign worker’s passport. It is blatantly illegal, and if you encounter such an agency, they should be reported to the organization Kav L’Oved: Tel: 02-624 2801; 03 6883766

SHORT-TERM PRIVATE NURSING CAREIf your parent is hospitalized, or you need extra hands at home, here are some numbers of private care agencies that provide private care on short-notice. It’s a good rule never to leave your loved one unattended in a hospital. • 1-700-70-70-50 (publicized at Hadassah Hospital) • 052-222-2220 (publicized at Shaarei Zedek Medical Center)

TEREM Use Terem services whenever something is not serious enough to go to the hospital, and there’s no way you can contact your own physician. In Jerusalem, their offices are in Romema, Old Katamon, and Talpiot. Click here for more information.

END OF LIFEShould your parent die at home, you must wait for a doctor to come and issue a death certificate (Teudat Ptira). Before you contact the chevra kaddisha, make several copies of this temporary certificate, as you will need to give a copy to the chevra kaddisha, and you will need a copy for yourself, to show at the Interior Ministry.

Then contact the chevra kaddisha to prepare the body for burial. All Israeli citizens are entitled to a free grave and burial. All costs are covered by the State. (Be advised, however, that you do have to pay in order to “reserve” a spot next to the deceased.)

Tombstone: We were also very satisfied with “David Bazani”, located at Har Menuchot. Talk to Yehuda. Tel: 050-576-0779. In general, be sure to check the tombstone carefully for any spelling mistakes, before making final payments. About 2 weeks after the death, go down to the Interior Ministry and get at least 6 copies of Teudat Ptira. You will need original copies of this document in order to close your parent’s bank accounts, and for other legal affairs. You will also need this original document in order to apply for a U.S. or other foreign death certificate. (NOTE: If your parent had U.S. citizenship, you don’t have to make an appointment with the U.S. Consulate to apply for a death certificate.) The original U.S. (or other nationality) death certificate is needed for probating your parent’s will, in order to release your deceased parent’s monies from abroad. (Ask the consular officer for several copies of the death certificate; you’ll need them for various other legal affairs.) Contact a lawyer for all the procedures regarding probating a will.

נער הייתי גם זקנתי ולא ראיתי צדיק נעזב

Tizku leMitzvot!

If you have any insights/information that you feel would benefit to others, please email them to me at jewishpapercuts@gmail.com, and I will consider incorporating them into this Guide.

Disclaimer: The author, Fern Allen, makes no warranty, representation or undertaking whether expressed or implied, and does not assume any legal liability, whether direct or indirect, or responsibility for the accuracy, completeness, or usefulness of any information provided. This guide is not an official reference source and should not be relied upon for that purpose. Information contained in this guide is for general education only. This guide provides links to websites and organizations that may be useful or of interest to users. These are for informational purposes only, and their inclusion does not imply endorsement of any vendor, product or service.

If you feel you have benefited from this Guide, and want to express your gratitude, please make a donation to Beit Melabev, Leah Porat 21, (POB 3622), Givat Mesua, Jerusalem 9103502.

WORKING IN PARTNERSHIP TO BUILD A STRONGER ISRAEL THROUGH ALIYAH

Please note that the information on this website is for general information purposes only, and does not constitute legal or other professional advice. You should always seek independent legal or other professional advice before acting or relying upon any of this information. In addition, whilst Nefesh B’Nefesh makes every effort to update the information on this website, Nefesh B’Nefesh does not guarantee the accuracy and currency of such information. For Nefesh B’Nefesh’s full terms and conditions, please click here.

Nefesh B’Nefesh in cooperation with the Israeli government and The Jewish Agency for Israel, is dedicated to revitalizing Aliyah from the USA, Canada and the UK by removing or minimizing the financial, professional, logistical and social obstacles of Aliyah and the move to Israel.